Etiology, Diagnosis and Management of Aortitis

• Published in: Cardiovascular and interventional radiology Vol. 43; no. 12; pp. 1821 - 1836
• Main Authors: Sharma, Sanjiv, Pandey, Niraj Nirmal, Sinha, Mumun, Chandrashekhara, S. H.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2020; Springer Nature B.V
• Subjects: Age Factors; Aneurysm; Aorta; Aorta - diagnostic imaging; Aortitis - diagnosis; Aortitis - etiology; Aortitis - surgery; Arteries; Autoimmune diseases; Cardiology; Cardiovascular system; Computed Tomography Angiography; Diagnosis; Diagnosis, Differential; Edema; Encephalopathy; Etiology; Female; Geographical distribution; Giant Cell Arteritis - diagnosis; Giant Cell Arteritis - surgery; Health services; Heart; Humans; Imaging; Inflammation; Laboratories; Male; Medical diagnosis; Medical imaging; Medical treatment; Medicine; Medicine & Public Health; Nuclear Medicine; Pulmonary arteries; Pulmonary artery; Radiology; Restenosis; Review; Stenosis; Stents; Surgery; Takayasu Arteritis - diagnosis; Ultrasound; Vascular Surgical Procedures - adverse effects; Vein & artery diseases; Ventricle; Aortitis; Giant cell arteritis; Disease activity; Takayasu arteritis
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-020-02486-6

Aortitis includes conditions with infectious or non-infectious etiology, characterized by inflammatory changes in one or more layers in aortic wall. Age at onset, geographic predilections, distribution and pattern of involvement in aorta, its branches and pulmonary arteries, and systemic associations provide a clue to etiology. Clinical presentations are often non-specific. An integrated approach including clinical, laboratory and imaging assessment is essential to confirm diagnosis and plan treatment. Assessment of disease activity is the key as it influences timing and outcome of treatment. Markers of activity include clinical, laboratory and imaging. Medical management remains the first-line therapy. Revascularization is indicated in the presence of hemodynamically significant stenosis and inactive disease. In the presence of flash pulmonary edema, left ventricular dysfunction or hypertensive encephalopathy, revascularization is performed irrespective of disease activity. Endovascular management is favored over surgery due to its high success and low restenosis rates. Symptomatic aneurysmal disease is usually managed by surgery.